Sympathetic overactivity in dialysis patients—Underappreciated and clinically consequential

Abstract

Cardiovascular morbidity and mortality remain frustratingly common in dialysis patients. A dearth of established evidence‐based treatment calls for alternative therapeutic avenues to be embraced. Sympathetic hyperactivity, predominantly due to afferent nerve signaling from the diseased native kidneys, has been established to be prognostic in the dialysis population for over 15 years. Despite this, tangible therapeutic interventions have, to date, been unsuccessful and the outlook for patients remains poor. This narrative review summarizes established experimental and clinical data, highlighting recent developments, and proposes why interventions to ameliorate sympathetic hyperactivity may well be beneficial for this high‐risk population.

Autonomic Nervous System Dysfunction in Peritoneal Dialysis Patients: An Underrecognized Cardiovascular Risk Factor?

“…Finally, the failed kidneys, independently of circulating uremic toxins, play a crucial role in ANS dysfunction. In ESKD patients, both the increased renal excitatory afferents and the impaired inhibitory renorenal reflex contribute to peripheral sympathoexcitatory outflow [47]. The fact that nephrectomy, renal denervation, and kidney transplanta-tion display corrective effects on BP control, lessen sympathetic hyperactivity, and improve vagal regulation of heart rate (HR) is also indicative of that role [48][49][50][51][52].…”